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Abstract

Delayed or impaired language development is a common developmental concern, yet there is little agreement about the criteria used to identify and classify language impairments in children. Children's language difficulties are at the interface between education, medicine and the allied professions, who may all adopt different approaches to conceptualising them. Our goal in this study was to use an online Delphi technique to see whether it was possible to achieve consensus among professionals on appropriate criteria for identifying children who might benefit from specialist services. We recruited a panel of 59 experts representing ten disciplines (including education, psychology, speech-language therapy/pathology, paediatrics and child psychiatry) from English-speaking countries (Australia, Canada, Ireland, New Zealand, United Kingdom and USA). The starting point for round 1 was a set of 46 statements based on articles and commentaries in a special issue of a journal focusing on this topic. Panel members rated each statement for both relevance and validity on a seven-point scale, and added free text comments. These responses were synthesised by the first two authors, who then removed, combined or modified items with a view to improving consensus. The resulting set of statements was returned to the panel for a second evaluation (round 2). Consensus (percentage reporting 'agree' or 'strongly agree') was at least 80 per cent for 24 of 27 round 2 statements, though many respondents qualified their response with written comments. These were again synthesised by the first two authors. The resulting consensus statement is reported here, with additional summary of relevant evidence, and a concluding commentary on residual disagreements and gaps in the evidence base.

Author Comment

This is a pre-print version of an article that is under review at PLOS One. In it, we describe a Delphi process designed to reach consensus on criteria for identifying children with significant language impairments.

Anonymised CATALISE Round 2 report

Additional Information

Competing Interests

Author Contributions

Dorothy V Bishop conceived and designed the experiments, performed the experiments, analyzed the data, wrote the paper, prepared figures and/or tables, reviewed drafts of the paper.

Margaret J Snowling conceived and designed the experiments, performed the experiments, wrote the paper, reviewed drafts of the paper.

Paul A Thompson performed the experiments, analyzed the data, wrote the paper, prepared figures and/or tables, reviewed drafts of the paper.

Trisha Greenhalgh conceived and designed the experiments, performed the experiments, wrote the paper, reviewed drafts of the paper.

Human Ethics

The following information was supplied relating to ethical approvals (i.e., approving body and any reference numbers):

The Medical Sciences Interdisciplinary Research Ethics Committee, University of Oxford (approval number: MS-IDREC-C1-2015-061). The committee approved for panel members to give written consent for their ratings to be used to derive a consensus statement.

Data Deposition

The following information was supplied regarding data availability:

We plan to deposit data in an Appendix with the published paper, which has been submitted to PLOS One.

Funding

This work was funded by Wellcome Trust Programme Grant no. 082498/Z/07/Z . The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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We have read with interest your new PeerJPreprint article entitled “CATALISE: A multinational and multidisciplinary Delphi consensus study. 1. Identifying language impairments in children”. In a spirit of collaboration, we are sending a few comments.

We noted on p. 10 of the article that a detailed literature review was not the aim, but as you will see, we do feel that omission of certain points might have affected the concluding statements presented in the paper. At the same time, we recognize that the conclusions reflect consensus, rather than the views of any individual.

Our comments follow, in order of the page number of the article that they pertain to.

p. 11, Supplementary comment to point 5: Displaying no intention to communicate by 2 to 3 years would indeed be extreme. This conclusion does not seem to reflect research suggesting that communicative intentions are restricted but not absent amongst 2-3 year olds with lower language abilities relative to age matches (see, for example, Rescorla 1998 regarding late talkers and O'Neill 2007 regarding children on a wait-list for SLP services).

p. 13, Supplementary comment to point 10, specifically "Also, many standardized tests are relatively insensitive to change over time". We thought you might be interested in recent longitudinal research demonstrating the sensitivity of standardized measures to change, reported by Foster-Cohen and van Bysterveldt (2016) in Speech Language and Hearing entitled “Assessing the communication development of children with language delay through parent multi-questionnaire reporting.”

p. 16, Supplementary comment to point 19. While we realize that "checklist" is part of the CCC-2 name, the term “checklist” as used here could easily lead a reader to think that the CCC-2 and LUI questionnaires did not undergo rigorous development, validity testing, and ultimately standardization. Instead, the term might be associated with the many informal lists (of varying quality) of language milestones currently circulating widely on the web and directed at parents. We suggest that the CCC-2 and the LUI be described as norm-referenced, standardized parent-report measures, thus highlighting their actual status and likely interest to clinicians and researchers.

The sentence preceding the description of checklists states, “Research on assessment and intervention for pragmatic problems is still in its infancy.” This statement may apply to intervention for pragmatic problems, but applies less well to research on assessment. Research has been conducted for measures such as the CCC-2 and the LUI for over 15 years, including studies to develop and validate the measures and independent investigations with various aims (e.g., Ketelaars et al., 2010 on the CCC-2 and longer term behavioural and quality of life outcomes; Miller et al., 2015 on the LUI's role in identifying subtle social communicative difficulties among siblings of children with autism; Pesco & O'Neill on the predictive validity of the LUI). Expert panels have also made independent recommendations for evaluating the pragmatic spoken language outcomes of children with ASD (e.g., Tager-Flusberg, 2009).

p. 20-21. Our last comment concerns two statements in the last section (section entitled “Research”). First, it is stated that the current consensus is that “…we lack suitable tools for the early identification of children at risk of longer-term language impairment: development of methods for distinguishing transient from persistent language problems should be a priority.” (p. 20). Second, it is stated that “Methods for reliable assessment of pragmatic difficulties are urgently required” (p. 21).

While we agree fully that the identification of children at-risk of longer term language impairment and the distinction of transient from persistent language problems should be a priority, the field is not entirely lacking in assessment tools whereby to accomplish this. Standardized, well-validated, well-researched tools do exist for measuring early vocabulary, grammar, and pragmatic language abilities. What would appear to be needed is in-depth, longitudinal research aimed at determining whether the best of the existing tools can distinguish trajectories indicating persistent vs. transient language difficulties.

[Disclosure: Financial - D. O’Neill is a Founder & President of Knowledge in Development, Inc. KID Inc. holds the copyright to, and publishes, the LUI commercially (LanguageUseInventory.com). KID Inc. receives all proceeds from the LUI and thus D. O’Neill is a beneficiary of proceeds from the Language Use Inventory. This is a continuing relationship.]

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